Transcript Slide 1

Delivering Care: Nurse Staffing in
Northern Ireland
Siobhan McIntyre
Regional Lead Nurse Consultant PHA
Chair of Delivering Care Regional Working Group
WSCNTL 2014, Kings Hall
Leading Care, Leading Teams - Innovating and Supporting Person-Centred Care
Community Nursing
Four key principles:
• Effectiveness: Timely access
• Integration:
Collaborative multi-disciplinary
working
• Efficiency:
right person, right place, right
time, right service, right
outcome
• Expertise:
Appropriately skilled
Mapping the Change in Service
Direction
 Reduction in inappropriate referral to hospital and NIAS
 Reduction in unscheduled care admissions
 Increased acute care delivery at home
 Consider the needs of the over 65yrs and patient groups for community
acute care teams/triage and see and treat protocols. Have an agreed
directory of service
 Expansion of 24 hour provision in primary care nursing
 Developing the right interfaces / secondary + primary care inc
diagnostics
 Choice of preferred place of care for palliative patients
 Nurse led clinics across primary and secondary services
 Disease prevention and early intervention
 Increased technological interventions
The Need to Transform
• Safe, effective, person centred
care;
• Increased demand for
efficiency and effectiveness;
• Changing population
demographics;
• Working closely with GPs;
• Changing patterns of disease
• eHealth / Telehealth;
• Changing lifestyle;
• Changing public expectations;
• Inequalities in health;
• Reconciliation in demand,
need & access.
Commissioning Framework
• An integrated vision and framework will be developed and led
by the PHA which outlines how district nursing services will be
modelled across each HSCT;
• The framework will seek out evidenced based and good
practice examples for district nursing services to support the
targeting of resources at local and regional level. This will
take cognisance of population needs and enhance delivery
closer to home and improve health and social care outcomes
and productivity;
• The framework will seek to capture the importance of
technology and to promote more effective mobile working
practices to support care delivery;
• The framework will be based on the principles for core district
nurse services aligned to Gps 24 hour provision and the
management of acutely ill patients in primary care.
‘The planning, provision and evaluation of
appropriate programmes of nursing care,
particularly for people discharged from
hospital and patients with complex needs;
long-term conditions, those who have a
disability, are frail or at the end of their life.”
(RCN, 2013)
• District nurses will be the key professionals
involved in planning and providing this care
within the following three care domains
– Acute care at home
– Complex care at home
– End of life care at home
Workforce Planning in Nursing & Midwiferywhat’s happening in Northern Ireland
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Policy/Strategy recommendations
DHSSPS Workforce Review 2014
Delivering care Regional Project for Normative Staffing
Caseload analysis for Community Nursing & Health Visiting
Clinical Nurse Specialist Job Plans
Community Information Systems
92% female, 44% part time
773.67 WTE district nursing staff across N.I.
Caseloads > 29,000 patients as at Dec 2013
Largest professional workforce in HSC
Responsible for continuous care provision
Delegate care to unregulated care workforce
Learning and development requirements
> post registration qualifications
> uptake on courses to meet TYC requirements
14. Professional and regulatory requirements
Strategic Drivers
Regional Policy and Strategy
• Transforming Your Care
• Quality 20:20
• The People’s Priorities
• A Partnership for Care
• Community indicators /caseload analysis
• Commissioning directions
• Integrated Care Partnerships.
Evidence Base Related to Staffing Levels and Patient Outcomes
• Link to patient outcomes http://www.rn4cast.eu/en/index.php
Evidence from Public Inquiries
• Francis
• Hine Inquiry
• Health Committee House of Commons
Context
High Quality
care in
community
Improving and
extending
services
Why?
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To promote a shared understanding between
professional, management, finance and human
resources colleagues of the essential components to
set and review nurse staffing establishments and
when commissioning new services to provide safe,
effective, person centred care.
To support general and professional managers in
presenting clearly the need for investment in nurse
staffing, within changing service profiles, particularly in
response to incremental service growth and TYC.
As a reference document for the nurse staffing levels
component within investment proposals.
Why Define a Range?
• Reasonable starting point for ‘conversation.’
• Not as prescriptive as a ratio and for district
nursing, it will be essential to consider cover
and hours of service for the future model of
service for an agreed population range.
Ref page 4, 2.10
‘It is anticipated that on occasion nurse staffing may be outside
the normal range. In such cases the Executive Director of
Nursing must provide assurances about the quality of nursing
care to these patients, and the efficient use of resources
through internal and external professional and other assurance
frameworks.’
Project Structure
Steering Group
Working Group
Additional
expertise
as
required
Who are the Partners?
• PHA
• HSC Trusts
• DHSSPS
• HSCB
• HR Reps
• Staff side
• PCC
Project Aim
To support the provision of quality care which is safe
and effective in hospital and community settings
through the development of a tool to determine staffing
ranges for the nursing and midwifery workforce in a
range of major specialities.
Phases
Phase 1 Acute Hospital Settings
Phase 2 Emergency Depts
Phase 3 District Nursing
Phase 4 Health Visiting
Process
Underpinned by:
• Communiqués
• Literature reviews/searches
• Interviews with HSC Trust Assistant Directors responsible
for nursing workforce
• Data gathering of current workforce and caseloads
• Gathering of international and national intelligence
around workforce planning in nursing
• Development and production of Part 2 of a framework
• External Critical Review
• Engagement with stakeholders
Delivering Care, Part 1
Assumptions of the
Framework
Staffing Ranges
Assumptions of the Framework
Key Performance Indicators
PUAA
Skill Mix
Management of Recruitment
Influencing Factors
Planned and Unplanned Absence Allowance
What is it?
Periods of absence from work, which can be described as
anticipated and, therefore, must be factored into the workforce
planning process.
Comprises:
• Annual leave
• Sickness absence
• Study leave
Evidence base:
• Telford (1979)
• Other professions: Consultant Contract
Framework (2003) , BASW, UK
Supervision Policy (2011)
• Auditor General Scotland (2002)
Planned and Unplanned Absence Allowance
What has changed since 2002?
Annual leave:
• Overall net increase of 16% following Agenda for Change
Study Leave
• 56% full time, 44% part time
• Increased intensity and complexity of patient care – practice and
competence training needs significantly increased
• Statutory/mandatory training
• Professional/regulatory updates and training in relation to preregistration nursing and midwifery mentorship
• Professional supervision
Planned and Unplanned Absence Allowance
So.......?
Year
2002
Year
2012
Annual
Leave:
13.5%
Sick Leave:
Study
Leave:
3%
Total
Allowance
22%
Annual
Leave:
15%
Sick Leave: Study
Leave:
5%
4%
Total
Allowance
24%
5.5%
Influencing Factors
• Competence skill set to work flexibly
• Management of absenteeism
• Constitution of district nursing teams
• Workforce
• Activity
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Caseload activity
Referral rates
Visiting patterns
24 hour services
Throughput
Acuity/Dependency
Seasonal Variations
• Environment and Support
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Geographical areas
Location of care
Population sizes
GP attachment
Skill mix
• Professional Regulatory Activity
• Compliance with professional regulatory
standards
• Supervision / Training
• Accountability and governance
requirements
Key Issues
• Need to understand how the district nursing
service has developed
• Review the integration of multi-disciplinary
working
• Need to review the alignment of core district
nurses to GP practices
• Requirement to enhance practice knowledge
and specialist skills
• Develop workforce planning methods
Progress
• Population and caseload management
• Consistent Data/activity collection
• Support and care for patients who are unwell, recovering
at home
• End of life/palliative care
• 24 hour provision
• Acute care at home
• Support and care for independence
• Promotion of technology and LTC
• Peer Review / Expert Reference Groups
• Users views of the service
• Communication and Dissemination
Measuring Impact and Enhancing the
Patient Experience
District nurses :
• contributing to population health needs
• leading care and contributing to healthy
communities
• working in partnership with social care
enhancing the quality of care.
• contributing to enhancing the patient
experience
Key Performance Indicators
Phase 1
Organisational:
• absence rates within nursing and midwifery teams;
• normative staffing ranges - including vacancy rates.
Safe and Effective Care:
• incidence of pressure ulcers
• falls
• omitted or delayed medications
Patient Experience:
• consistent delivery of nursing/midwifery care against
identified need
• involvement of the person receiving care in decisions
made about their nursing/midwifery care
• time spent by nurses and midwives with the patient
‘Should quality indicators begin to fall below the accepted
level of achievement, staffing levels should be reviewed as
one of the lines of enquiry of attributable causes.’
Process for Phase 3
 To conduct an academic literature review on district nursing
workforce models;
 To build on the work already collated with HSCTs from Ecats;
 To build on the commissioning framework developed for
district nursing in Northern Ireland;
 To liaise with key partners re critical success factors for
training and development;
 To agree a regional workforce and caseload range for district
nursing in Northern Ireland;
 To agree the influencing factors as they relate to district
nursing practice;
 To agree service definitions;
 To agree KPIs as they will relate to the workforce planning
framework for District Nursing;
 To set up user feedback forums for the project.
Thank you
[email protected]
Telephone ; 02871860086
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